Suspected pulmonary metastases: correlation of chest x-ray, whole lung tomograms, and operative findings.

Chest x-rays, whole lung tomograms, and operative findings were correlated in 152 patients with an extrathoracic malignancy who underwent 182 thoracotomies for the evaluation of pulmonary nodules. Among 25 patients with a normal chest x-ray but one or more pulmonary nodules demonstrated by whole lung tomography, 19 had metastatic disease documented at thoracotomy. Of 64 patients with unilateral nodules seen on conventional chest x-ray, 10 of 32 with sarcoma, 2 of 7 with melanoma, but only 2 of 25 with carcinoma had bilateral nodules demonstrated by tomography. At thoracotomy, 8 of 38 patients in whom a solitary nodule was present on both chest x-ray and on tomogram had multiple nodules. Similarly, 35 of 48 patients with more nodules seen on the tomograms than on the chest x-ray had even more extensive metastatic disease demonstrated by operation. Among patients who had resection of all metastatic pulmonary nodules, 50% of those with carcinoma and 32% of those with sarcoma who underwent resection of a solitary nodule approached that of patients with carcinoma. These findings suggest that whole lung tomograms contribute to the determination of the extent of pulmonary metastasis in patients with solid malignancies, even in the presence of a negative chest x-ray. The improved long term survival achieved by resection of these metastases may be partially attributed to this screening procedure.